Syncope Questions & Answers

Updated: Jan 13, 2017
  • Author: Rumm Morag, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Questions & Answers

Overview

How is syncope defined?

What is included in the evaluation of syncope?

What should be the focus of history in a patient with syncope?

What questions should be asked to evaluate syncope?

What are presyncopal symptoms?

What medical history information should be obtained in the evaluation of syncope?

What should be included in the physical exam for syncope?

What tests are recommended for the diagnosis of syncope?

What is the role of imaging studies in the evaluation of syncope?

What are the ACEP consensus diagnostic guidelines for syncope?

Which tests and procedures may be helpful in the diagnosis of syncope?

What is included in the prehospital management of syncope?

What are the initial emergency department (ED) interventions in the treatment of syncope?

What are the treatment options for syncope?

How is syncope defined?

What is the prevalence of syncope?

How should syncope be initially categorized?

How does hospitalization affect outcomes in syncope?

What are the ACEP guideline criteria for inpatient treatment of syncope?

What is the pathophysiology of syncope?

What is the role of cerebral perfusion in the pathophysiology of syncope?

Which conditions can mimic syncope?

What causes syncope?

Which factors contribute to the etiology of syncope?

What are the signs and symptoms of a ventricular arrhythmia etiology in syncope?

What are the signs and symptoms of a supraventricular tachyarrhythmia etiology in syncope?

What are the signs and symptoms of a bradyarrhythmias etiology in syncope?

What are the signs and symptoms of a cardiac outflow obstruction etiology in syncope?

Which cardiac etiologies of syncope may lead to sudden death?

What causes reflex (neurally mediated) syncope?

What causes vasovagal syncope?

What causes situational syncope?

Which conditions may be the underlying cause of orthostatic syncope?

What is the pathophysiology of orthostatic syncope?

What is the prevalence of syncope in the US?

What is the global prevalence of syncope?

How does the prevalence of syncope vary by race, age, and sex?

What is the prognosis of cardiac syncope?

What can improve the prognosis of cardiac syncope?

What is the prognosis of noncardiac syncope?

What is the prognosis of vasovagal syncope?

What is the prognosis of situational and orthostatic syncope?

What is the prognosis of syncope when the etiology is unknown?

What are complications of recurrent falls due to syncope?

Which symptoms increase the risk of cardiac syncope?

What is the prevalence of recurrent syncope?

What is associated with a poor prognosis in syncope?

How does the prognosis of cardiac syncope compare to noncardiac syncope?

What is the mortality risk for syncope?

How are patients at risk for syncope identified?

What is the San Francisco Syncope Rule (SFSR) for identifying patients at immediate risk?

What are the ROSE (Risk stratification Of Syncope in the Emergency department) criteria for predicting serious outcomes in syncope?

Which factors increase the mortality risk for syncope?

What are the quality and accuracy of the OESIL score and SFSR criteria in predicting short-term outcomes in syncope?

What information about syncope should a patient be given?

Presentation

How is syncope diagnosed?

What should be included in the account of the suspected syncope event?

What are precipitating factors in syncope?

How does knowing the activity prior to syncope help in determining etiology?

Which questions should be asked as part of the evaluation of syncope?

What are the signs and symptoms of syncope?

What is the duration of symptoms preceding a syncopal episode?

Which symptoms should be reviewed in the evaluation of syncope?

How is syncope differentiated from seizures?

Which symptoms suggest a seizure rather than syncope?

What is the significance of postevent confusion when discriminating between syncope and seizure?

Which drugs may cause syncope?

What should be the focus of history in the evaluation of syncope?

Which conditions should be included in the differential diagnoses of syncope?

Is a physical exam required in the ED when syncope is suspected?

What is the role of vital signs in the evaluation of syncope?

What is the role of glucose testing in the evaluation for syncope?

What cardiopulmonary exam findings are helpful in determining the etiology of syncope?

Why is a neurological exam performed in the evaluation of syncope?

What does trauma suggest in the evaluation of syncope?

What is the role of stool guaiac exam in the evaluation of syncope?

What is the role of the Hallpike maneuver in the evaluation of syncope?

Which test may be performed to identify postural hypotension in syncope?

What is the role of carotid sinus massage in the evaluation of syncope?

DDX

Who should be involved in a recommendation for return to activity following syncope?

What is the clinical presentation of syncope in patients with dementia?

What should be included in diagnostic considerations for syncope?

Which vasomotor/vascular conditions should be considered in patients with suspected syncope?

Which cardiac conditions should be considered in patients with suspected syncope?

Which situational conditions should be considered in patients with suspected syncope?

Which metabolic or endocrine conditions should be considered in patients with suspected syncope?

Which central nervous system conditions should be considered in patients with suspected syncope?

What are the differential diagnoses for Syncope?

Workup

What is the role of lab studies in the evaluation of syncope?

What is the role of serum glucose testing in the workup of syncope?

What is the role of complete blood count (CBC) in the workup of syncope?

What is the role of serum electrolyte levels and renal function tests in the workup of syncope?

What is the role of cardiac enzyme testing in the workup of syncope?

What is the role of total creatine kinase (CK) in the workup of syncope?

What is the role of urinalysis in the workup of syncope?

What is the role of radiography in the workup of syncope?

What is the role of head CT scanning in the workup of syncope?

What is the role of chest and abdomen CT scanning in the workup of syncope?

What is the role of MRI in the workup of syncope?

What is the role of ventilation-perfusion (V/Q) scanning in the workup of syncope?

What is the role of echocardiography (echo) in the workup of syncope?

What is the role of electrocardiography in the workup of syncope?

When is a Holter monitor or loop event recorder indicated in the workup of syncope?

When is a head-up tilt-table test indicated in the workup of syncope?

What is the role of EEG in the workup of syncope?

What is the role of stress testing or electrophysiologic studies in the workup of syncope?

What is the role of carotid sinus massage in the workup of syncope?

Treatment

What is included in prehospital management of syncope?

What are the treatment options for syncope?

What initial interventions are performed in emergency department (ED) for syncope?

Why are ECG and rapid blood glucose testing initially performed in the management of syncope?

What indicates an emergency in syncope?

What is the focus of treatment for situational syncope?

What is the focus of treatment for orthostatic syncope?

Which supplemental therapies may be included in the emergency department (ED) management of syncope?

What are the benefits of specialized syncope units in the emergency department (ED)?

What are the treatment options for cardiac arrhythmic syncope?

What is the role of cardiac pacing in the treatment of syncope?

What are the treatment options for cardiac mechanical syncope?

When is transfer indicated in patients with syncope?

Which specialist consultations are needed for the management of syncope?

Medications

What are the goals of drug treatment for syncope?

Which medications in the drug class Vasopressor are used in the treatment of Syncope?

Which medications in the drug class Benzodiazepines are used in the treatment of Syncope?

Which medications in the drug class Nutrient Supplements are used in the treatment of Syncope?

Which medications in the drug class Anticholinergics are used in the treatment of Syncope?